Individual provider Active NPI

Brenda Wong

  • Certified Registered Nurse Anesthetist
  • Mount Holly, NJ
National Provider Identifier
1104675412
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NR22515300 Issued in NJ
Practice address
175 Madison Ave FL 1
Mount Holly, NJ 08060-2099
Phone
(856) 430-9427
NPI assigned
May 17, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 26NR22515300 NJ Primary

Addresses

Primary practice location

175 Madison Ave FL 1
Mount Holly, NJ 08060-2099

Mailing address

1126 E Palmer St Unit 2
Philadelphia, PA 19125-4242
Phone (646) 323-7963

Other practice location 1

218 Sunset Rd Fl 2
Willingboro, NJ 08046-1110
Phone (609) 835-2900

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bwong276014@directvirtua.org
Direct Messaging Address bwong276014@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240730000009 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 5991242703 Reassigns benefits to 1 organization
I20250403003457 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5991242703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

175 Madison Ave
Mount Holly, NJ 08060-2038
Phone (856) 247-7260

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Sep 1, 2024 Accepting new patients
Society Hill Anesthesia Consultants, PC CurrentSince Jan 17, 2025 Accepting new patients
Virtua Medical Group, PA CurrentSince Sep 1, 2024 Accepting new patients
Virtua Medical Group, PA Nurse Anesthetist, Certified Registered Current Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

175 Madison Ave
Fl 1
Mount Holly, NJ 08060
Phone (609) 914-6000

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

218 Sunset Rd
Fl 2
Willingboro, NJ 08046
Phone (609) 444-0599

301 S 8th St
Ste 2L
Philadelphia, PA 19106
Phone (215) 829-7260

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

Interoperability endpoints

  • Direct secure messaging: bwong276014@directvirtua.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1104675412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 E PALMER ST UNIT 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191254242",
            "telephone_number": "646-323-7963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MADISON AVE FL 1",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080602099",
            "telephone_number": "856-430-9427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "218 Sunset Rd Fl 2",
            "address_purpose": "LOCATION",
            "city": "Willingboro",
            "state": "NJ",
            "postal_code": "080461110",
            "country_code": "US",
            "telephone_number": "609-835-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "BRENDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-17",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NR22515300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bwong276014@directvirtua.org",
            "affiliation": "N",
            "address_1": "218 Sunset Rd Fl 2",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080461110",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bwong276014@directvirtua.org",
            "affiliation": "N",
            "address_1": "175 Madison Ave Fl 1",
            "city": "Mount Holly",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080602099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Holly, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.